ONE Policies
Introduction
Orthopaedics Northeast, P.C. (ONE) is pleased to serve you and is committed to providing you with the best possible care for your needs. This brochure was created to familiarize our patients with our practice, office procedures and policies. Please review this information and feel free to ask any questions you may have about your care at Orthopaedics Northeast. Select from the following:
Appointments
Patients are seen by appointment only during the normal clinic hours of 8 a.m. - 5 p.m., Monday through Friday. In case of emergency you may contact the provider on call 24 hours a day by calling (260) 484-8551 or toll free at (800) 589-8551.
To schedule an appointment, call (260) 484-8551, ext. 2401 or (800) 589-8551, ext. 2401. To change or cancel an appointment, call (260) 484-8551, ext. 2401 or (800) 589-8551, ext. 2401 and give the scheduler the name of the physician you are scheduled to see, the date and time of your appointment and your name. To avoid a service charge, please give a 24-hour advance notice if you are unable to keep your appointment.
Questions Regarding Care and Treatment
Our staff will be happy to answer your questions or forward them to your physician. Call (260) 484-8551, ext. 2402 and ask for the office nurse between the hours of 8 a.m. and 5 p.m. After 5 p.m., only emergency calls are taken. In case of emergency you may contact the provider on call 24 hours a day by calling (260) 484-8551 or toll free at (800) 589-8551.
Prescriptions
Narcotic prescriptions will not be refilled after 5 p.m. Monday through Friday, nor will they be refilled on weekends. This policy is for the protection of our patients. The physician on call may not be as familiar with your medical history as is your primary ONE physician. An emergency room visit may be required to receive pain medication outside of normal office hours.
Financial and Billing Information
Before seeing one of our physicians, we recommend that you contact your insurance provider regarding coverage of services at Orthopaedics Northeast. Because so many variables exist with insurance plans, knowing your coverage will help insure that you are not left responsible for large out-of-pocket expenses.
If provided with complete billing information prior to your service, we will submit a claim directly to your insurance company for processing. However, the responsibility for payment for services rendered rests directly with you. If payment is not received from your insurance carrier within sixty (60) days of billing, you may be asked to contact your carrier to resolve the issue. If there is still no payment within ninety (90) days, you will be asked to make full payment for the services rendered.
It is important to realize that many insurance companies do not cover the full amount of physician charges. There often is a deductible and/or co-insurance amount due from the patient. Insurance companies use the term UCR -- an acronym for usual, customary and reasonable -- to describe how they determine the amount of your doctors' fee your policy will cover. Insurance companies set their own UCR levels based on a variety of considerations, including their desire to minimize costs. UCR is not a calculation of "normal" or "usual" fees charged in the area. Amounts not covered by your insurance company due to UCR will need to be paid by the patient.
Liability / Injury Cases
Payment of the bill is the responsibility of the individual who has received the treatment, not the individual who is being sued. For this reason, as well as the fact that lawsuits may go on for a protracted period of time, our bill should be settled promptly or payment arrangements should be made with our collection department.
Medicaid
Providing we have the correct information, your claim will be filed directly with Medicaid. If your plan requires referral from a primary care physician and/or prior authorization, you must follow those requirements. Failure to do so may cause a delay in your continued service. Spend down amounts are due upon notification.
Medicare
Providing we have the correct information, your claim will be filed directly with Medicare. We do accept assignment; deductible and co-insurance amounts will be billed to your secondary insurance carrier if information is available, or to you if there is none. You may be asked to sign a form (waiver) stating that you will be responsible for other services rendered that Medicare may consider to be unnecessary. Non-covered services will be billed to the patient, as well as any services that may be denied and for which a waiver form was signed at the time of service.
Worker's Compensation
If a patient advises that medical services are related to a worker's compensation matter, we will obtain verification of this from the employer. Submitting already identified case numbers from the Industrial Board will aid in processing your claim. Because many worker's compensation cases are denied after review, we will also obtain your medical insurance information. For more information about worker's compensation, please call our office at (260) 484-8551 and ask for the worker's compensation department.
Patients with no insurance coverage are expected to pay in full for services as they are rendered. Payment in full for services on the day of service may be eligible for a discount. If surgery is elective in nature, payment must be made prior to the surgery; this too may be eligible for a discount.
No Insurance
If you would like to discuss the possibility of a payment plan or assistance based upon our guidelines for indigent care, please call our collections department at (260) 484-8551 ext. 2405.
Privacy Policy
ORTHOPAEDICS NORTHEAST
HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact Pat Weicker at (260) 484-8551 ext. 2308.
WHO WILL FOLLOW THIS NOTICE.
This notice describes Orthopaedics Northeast (ONE) Policies and Procedures and that of:
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Any health care professional authorized to enter information into your medical record.
- All departments and units of the practice.
- Any member of a volunteer group we allow to help you while you are in the practice.
- All workforce members.
- All ONE entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital operations purposes described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
ONE understands that medical information about you and your health is personal. ONE is committed to protecting medical information about you. ONE creates a record of the care and services you receive at the practice. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the practice, whether made by practice personnel or your personal doctor. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
Law requires us to:
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make sure medical information that identifies you is kept private;
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give you this notice of our legal duties and privacy practices with respect to medical information about you;
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and follow the terms of the notice that is currently in effect.
HOW ORTHOPAEDICS NORTHEAST MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The following categories describe different ways that ONE may use and disclose medical information. For each category of uses or disclosures we will explain what we mean. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment.
ONE may use medical information about you to provide you with medical treatment or services. ONE may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at the practice. Different departments of the practice also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We may at times display photos of our patients, with their permission. We also may disclose medical information about you to people outside the practice who may be involved in your medical care after you leave the practice, such as family members, clergy or others we use to provide services that are part of your care. In the course of your treatment, verbal communications between ONE staff members and others related to your healthcare may be overheard by non-staff members in our office. ONE will make their best efforts to keep your health information as private as possible.
For Payment.
ONE may use and disclose medical information about you so that the treatment and services you receive at the practice may be billed and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about treatment you received at the practice so your health plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations.
ONE may use and disclose medical information about you for practice operations. These uses and disclosures are necessary to run the practice and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians, medical students, and other practice personnel for review and learning purposes. We may also combine the medical information we have with medical information from other physicians to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are. ONE may have occasion to use your name as a part of the operational process of servicing our patients. ONE staff will make their best effort to protect any information, written or oral, from being seen or overheard by those not authorized to receive the information.
Appointment Reminders.
ONE may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at our practice, this may done by phone. A message may be left at the number you provided.
Treatment Alternatives.
ONE may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services.
ONE may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care.
ONE may release medical information about you to a friend or family member who is involved in your medical care. ONE may also give information to someone who helps pay for your care. With your authorization, ONE may also tell your family or friends your condition.
As Required By Law.
ONE will disclose medical information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety.
ONE may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
SPECIAL SITUATIONS
Organ and Tissue Donation.
If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans.
If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority. We may use and disclose to components of the Department of Veterans Affairs medical information about you to determine whether you are eligible for certain benefits.
Worker’s Compensation.
ONE may release medical information about you for worker’s compensation or similar programs to your employer, or your employer’s designee (insurance company, case manager). These programs provide benefits for work-related injuries or illness.
Public Health Risks.
ONE may disclose medical information about you for public health activities. These activities generally include the following:
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prevent or control disease, injury or disability;
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to report births and deaths;
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to report child abuse or neglect;
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to report reactions to medications or problems with products;
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to notify people of recalls of products they may be using;
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to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
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to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities.
ONE may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to obtain your authorization or to obtain an order protecting or disclosing the information requested.
Law Enforcement.
ONE may release medical information if asked to do so by a law enforcement official:
- In response to a court order, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the practice; and
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors.
ONE may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities.
ONE may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others.
ONE may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Inmates.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights regarding medical information we maintain about you:
- Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
- To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing, using the designated form, to ONE’s Release of Information Department. If you request a copy of the information, the request would be forwarded to Midwest Medical Copy Service and a fee for the costs of copying, mailing or other supplies associated with your request would apply.
- ONE may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend.
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the practice.
To request an amendment, your request must be made in writing, using the designated form, and submitted in a sealed envelope, to any of our offices, made to the attention of the Privacy Officer. In addition, you must provide a reason that supports your request.
ONE may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept by or for the practice;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures.
You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you outside of treatment, payment, or operational purposes and without an authorization. An example of this type of disclosure would be information faxed to the wrong number.
To request this list or accounting of disclosures, you must submit your request in writing, using the designated form, and submitted in a sealed envelope, to any of our offices, made to the attention of the Privacy Officer. Your request must state a time period, which may not be longer than six years and may not include dates before April 16, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operation.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing, using the designated form, and submitted in a sealed envelope, to any of our offices, made to the attention of the Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing, using the designated form, and submitted in a sealed envelope, to any of our offices, made to the attention of the Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice.
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website, www. OrthoNE.com.
To obtain a paper copy of this notice, you may obtain one at the front desk of any of our offices.
Various Forms needed for the above mentioned requests are available at ONE’s front desk.
CHANGES TO THIS NOTICE
ONE reserves the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the practice office. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register for treatment or health care services as an outpatient, we will offer you a copy of the current notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the practice by contacting Joyce Kyle at Tri-State Medical Group, 260-422-7524 or with the Secretary of the Department of Health and Human Services. All complaints will have to be submitted in writing.
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
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